不同功率高强度聚焦超声治疗人胰腺癌移植瘤初步实验研究

目的：观察不同功率高强度聚焦超声(HIFU)治疗人胰腺癌移植瘤的有效性和安全性。方法建立裸小鼠人胰腺癌YY-1细胞移植瘤模型,将荷瘤鼠分为低功率HIFU治疗组(200 W,n=10)、高功率HIFU治疗组(300 W,n=10)和空白对照组(n=10)。观察肿瘤体积变化、肿瘤生长速率及治疗不良反应,末端脱氧核苷酸转移酶、生物素dUTP切口末端标记(TUNEL)法检测各组肿瘤细胞凋亡率。结果低功率组、高功率组肿瘤体积、生长速率均明显低于对照组(P<0.05),两治疗组间比较差异无统计学意义(P>0.05)。与低功率组相比,高功率组不良反应增多(P<0.05),主要为皮肤灼伤(60%)和声通道损伤(20%)。治疗后7 d、14 d,低功率组和高功率组细胞凋亡率均高于对照组(P<0.05),两治疗组间细胞凋亡率差异无统计学意义(P>0.05)。结论低功率HIFU治疗胰腺癌移植瘤有效,且安全性更好。     

高强度聚焦超声治疗晚期胰腺癌疼痛疗效分析

 目的 探讨高强度聚焦超声治疗晚期胰腺癌疼痛的疗效和安全性.方法 对22例晚期胰腺癌行高强度聚焦超声治疗,观察治疗前后的疼痛评分、生活质量评分变化及不良反应.结果 全组疼痛缓解总有效率为85％,其中完全缓解10.00％ (2/20),部分缓解55.00％ (11/20),轻微缓解25.00％ (5/20),无效10.00％(2/20).未发生严重并发症.结论 高强度聚焦超声是一种治疗晚期胰腺癌疼痛的有效方法,具有无创和较高的安全性.     

高强度聚焦超声治疗晚期胰腺癌疼痛20例

目前,癌性疼痛的治疗仍然以药物为主。单一药物止痛用药量大,用药频繁,不良反应多。笔者对42例晚期胰腺癌疼痛患者,分别行单纯药物镇痛和高强度聚焦超声（High intensity focused ultrasound,HIFU）加药物治疗,后者用药量显著减少,药物依赖性产生的时间明显延长,为癌性疼痛镇痛治疗探索出一种新方法。     

高强度聚焦超声治疗胰腺癌患者苏醒延迟1例

1病例报告患者女,75岁。诊断为胰腺癌,行高强度聚焦超声(HIFU)治疗。患者8:30入手术室血压(BP)150/90mmHg,心率(HR)70/min,血氧饱和度(SO2)0.96。给予地塞米松10mg、东莨菪碱0.3mg静脉注射,麻醉诱导采用咪达唑仑0.05mg/kg、芬太尼/、丙泊酚/、罗库溴铵/。肌松     

吉西他滨联合高强度聚焦超声治疗晚期胰腺癌疗效观察

目的:观察吉西他滨联合高强度聚焦超声(HIFU)治疗晚期胰腺癌的近期疗效和安全性。方法:选择晚期胰腺癌50例,分为观察组23例和对照组27例。对照组采用静脉滴注吉西他滨治疗;观察组在对照组基础上增加HIFU治疗,比较两组近期疗效和不良反应等。结果:观察组完全缓解(CR)17.4%、部分缓解(PR)30.4%,稳定(SD)30.4%,进展(PD)21.7%;对照组CR 3.7%,PR18.5%,SD 37.0%,PD 40.7%。观察组CR率、PR率显著高于对照组(P<0.05)。观察组临床受益反应(CBR)56.5%,对照组25.9%;两组比较,差异显著(P<0.05)。治疗后,观察组疼痛强度评分非常显著低于对照组(P<0.01)。观察组无脏器穿孔、大出血、腹膜炎等并发症发生。结论:吉西他滨联合HIFU治疗晚期胰腺癌疗效较好,且安全。     

高强度超声聚焦刀治疗晚期胰腺癌疼痛

目的：探讨高强度超声聚焦刀对于晚期胰腺癌疼痛治疗的价值。方法：应用超声聚焦刀治疗晚期胰腺癌37例，用11点数字评分法（NRS-11）评价比较治疗前后患者的疼痛情况。结果：治疗后患者的NRS-11明显较治疗前降低（P〈0．05）。结论：超声聚焦刀对晚期胰腺癌患者，在改善生活质量、缓解疼痛方面作用显著。     

高强度聚焦超声治疗肝癌研究进展

原发性肝癌(HCO)首选手术治疗,但许多病例在被发现时已失去了手术机会。对此,主要采取介入治疗,如选择性肝动脉栓塞化疗(TACE)、B超引导下经皮肝癌无水乙醇注射(PEIT)等,上述疗法虽能取得一定疗效,但多为侵袭性手段,亦有一定局限性。近10余年来,随着超声治疗学的飞速发展,新兴起的高强度聚焦超声(high intensity focused ultrasound,HIFU)作为一种无创性非手术疗法,在实验研究和临床应用方面取得了一定进展。     

高强度聚焦超声治疗肘关节区复发性神经纤维瘤1例

1 病例报告患者女性,45岁,发现左上臂肿物10年,术后局部复发伴疼痛、肿胀并进行性加重11个月,于2007年3月12日入我院.入院查体:左上臂下段外侧可见一长约20 cm的弧行手术疤痕,愈合良好,疤痕上方可触及一约10 cm×8.5 cm的肿物,质硬、固定、轻度压痛,局部皮温较高伴肿胀明显,沿手术疤痕中点测量上臂周径为31 cm,上方1 cm处周径为32 cm.左前臂近肘关节处轻度肿胀,疤痕下方可及一直径约3 cm的肿物,性质相同.左肘关节被动屈曲位,最大伸展度为135°,活动显著受限.其他神经系统查体未见显著异常.局部超声及CT、MRI等检查均提示:左肘关节外上、下方富血供不规则占位.原手术病理切片经我院及解放军总医院会诊,均认为是神经纤维瘤.入院诊断结果:左上肢神经纤维瘤,术后复发.     

动脉灌注化疗联合高强度聚焦超声治疗胰腺癌的临床研究

目的 评价动脉灌注化疗联合高强度聚焦超声治疗胰腺癌的临床价值.方法 将64例不能手术切除的胰腺癌患者随机分成2组,研究组32例采用动脉灌注化疗联合高强度聚焦超声方案;对照组32例采用动脉灌注化疗方案.观察两组方案的有效率、临床收益率、不良反应和生存期.结果 两组近期有效率(PR + MR)分别为55.56%和28.57...     

MRI评价高强度聚焦超声治疗子宫肌瘤对骶骨的影响

目的:应用MRI成像观察并检测子宫肌瘤高强度聚焦超声(HIFU)治疗前后骶骨MRI信号,评价HIFU治疗子宫肌瘤对骶骨影响的价值.材料和方法:对50例子宫肌瘤患者HIFU治疗前后行MRI成像检查,观察骶骨MRI信号的变化并在T1WI、T2WI和增强扫描矢状面上测定其信号值.结果:HIFU治疗子宫肌瘤后部分患者骶骨出现异常信号,其MRI T2WI信号强度增高,TIWI信号强度降低.结论:MRI可有效评价HIFU治疗子宫肌瘤对骶骨的影响.     

肋骨和肺组织阻挡对高强度聚焦超声破坏犬肝组织的影响

目的 :探讨肋骨和肺组织阻挡对高强度聚焦超声 (high intensityfocusedultrasound ,HIFU)破坏犬肝组织的影响。方法 :2 0条实验犬随机平均分为对照组和手术组 ,手术组模拟行肋骨部分切除、肋膈角闭合术 (partialcostectomyandcostophrenicangleclosure,PCCAC) ;以 0 .8MHz、焦距 12 0mm、定点点打、声功率 2 2 0W连续照射两组实验犬肝右叶 90s ,对肝毁损灶进行面积和体积测定及病理学检查。结果 :超声显示手术组犬肝形成 (1.0 4± 0 .2 3)cm2 回声增强区 ,对照组没有观察到回声增强区 ;肉眼下实验犬肝毁损灶体积 (3.2 4± 0 .4 7)cm3 ,与对照组具有显著性差异 (P<0 .0 5 ) ;对毁损灶的HE染色证实手术组犬肝毁损灶的坏死程度明显增强 ,范围增大。结论 :肋骨和含气肺组织的遮挡对HIFU破坏犬肝组织具有明显的负影响 ,行PCCAC后可以有效提高HIFU在肝脏治疗靶区内的有效能量 ,减少衰减     

高强度聚焦超声治疗子宫腺肌病临床研究进展

高强度聚焦超声(high intensity focused ultrasound,HIFU)治疗为近年来兴起的一项无创技术,因其安全、无创、无辐射、可重复等优点,广泛应用于各种实体肿瘤的治疗。本文对HIFU治疗子宫腺肌病的作用机制、适应证、禁忌证、治疗方法、安全性及有效性和并发症进行综述。     

DWI监测子宫肌瘤HIFU术后早期疗效的价值

目的:探讨DWI评价子宫肌瘤高强度聚焦超声(high-intensity focused ultrasound,HIFU)术后早期疗效的价值。方法:24例患者共26个肌瘤在HIFU术前1周及消融后1周行DWI、CE-MRI检查,分析残留肌瘤组织的DWI信号特征,并比较DWI与CE-MRI测得的残留肌瘤组织体积。结果:24例DWI、CE-MRI均能发现残留肌瘤组织;HIFU术后1周子宫肌瘤残留区DWI信号较前略升高;术后1周残留部分平均ADC值为(1.552±0.142)×10-3 mm2/s,较术前有升高,且差异有统计学意义(P<0.005)。DWI与CE-MRI对术后1周残留组织平均体积的测量,差异无统计学意义(P>0.05)。Pearson法显示,DWI与CE-MRI测量肌瘤残留部分体积呈高度相关(r=0.95,P<0.005)。结论:DWI是监测早期子宫肌瘤HIFU术后不完全消融非常有效的方法。     

Evaluation of the therapeutic efficacy of high-intensity focused ultrasound ablation of hepatocellular carcinoma by three-dimensional sonography with a perflubutane-based contrast agent

Objective

We performed contrast-enhanced three-dimensional sonography (CE 3D US) with a perflubutane-based contrast agent to immediately evaluate the completeness of ablation of small hepatocellular carcinoma (HCC) lesions by extracorporeal high-intensity focused ultrasound (HIFU).

Subjects and methods

Twenty-one HCC lesions were treated by a single ultrasound-guided HIFU ablation session, and CE 3D US was performed before, immediately after, and 1 week, and 1 month after HIFU, and contrast-enhanced CT (CE CT) or contrast-enhanced MRI (CE MRI) was performed before HIFU, 1 week and 1 month after HIFU, and during the follow-up period.

Results

Immediately and 1 month after HIFU, 17 lesions were evaluated as adequately ablated by CE 3D US, and the other 4 lesions as residual tumors. One month after HIFU, 18 were evaluated as adequately ablated by CE CT or CE MRI, and the other 3 as residual tumors. The evaluation by CE 3D US immediately after HIFU and by CE CT or CE MRI 1 month after HIFU was concordant with 20 lesions. The kappa value for agreement between the findings of CE 3D US and other modalities by two blinded observers was 0.83. When the 1-month CE CT or CE MRI findings were used as the reference standard, the sensitivity, specificity, and accuracy of CE 3D US immediately after HIFU for the diagnosis of the adequate ablation were 100%, 75%, and 95%, respectively.

Conclusion

CE 3D US appears to be a useful method for immediate evaluation of therapeutic efficacy of HIFU ablation of HCC lesions.     

Biological characteristics of gene expression features in pancreatic cancer cells induced by proton and X-ray irradiation

Abstract

Background: Radiation therapy is an important alternative treatment for advanced cancer. The aim of the current study was to disclose distinct alterations of the biological characteristics of gene expression features in pancreatic cancer cells, MIAPaCa-2, following proton and X-ray irradiation.

Materials and methods: Using cDNA microarray, we examined the gene expression alterations of MIAPaCa-2 cells following proton or X-ray irradiation. We also isolated the surviving MIAPaCa-2 cells after irradiation and analyzed their gene expression profiles.

Results: Although the cytocidal effects of both types of irradiation were similar at sufficient doses in vitro and in vivo, the affected gene expression profile alterations of MIAPaCa-2 cells irradiated with protons were distinct from those irradiated with X-ray. Interestingly, clustering analysis of gene expression of the surviving MIAPaCa-2 cells was also completely discernible between the two types of irradiation. However, a similar cytocidal effect was still observed in the proton- and X-ray-irradiated surviving cells after re-irradiation, commonly showing biological effects related to apoptosis and cell cycle processes.

Conclusions: Proton irradiation treatment for pancreatic cancer provides the distinct biological effect of steady gene expression alterations compared to X-ray irradiation; however, surviving cells from both types of irradiation were still susceptible to the cytocidal effects induced by proton re-irradiation treatment.     

Effect of microbubble contrast agent during high intensity focused ultrasound ablation on rabbit liver in vivo

Objective

To evaluate the effect of a microbubble contrast agent (SonoVue) during HIFU ablation of a rabbit liver.

Materials and methods

HIFU ablations (intensity of 400 W/cm² for 4 s, six times, with a 5 s interval between exposures) were performed upon 16 in vivo rabbit livers before and after intravenous injection of a microbubble contrast agent (0.8 ml). A Wilcoxon signed rank test was used to compare mean ablation volume and time required to tissue ablation on real-time US. Shape of ablation and pattern of coagulative necrosis were analyzed by Fisher's exact test.

Results

The volume of coagulative necrosis was significantly larger in the combination microbubble and HIFU group than in the HIFU alone group (P < 0.05). Also, time to reach ablation was shorter in the combination microbubble and HIFU group than in the HIFU alone group (P < 0.05). When analyzing the shape of tissue ablation, a pyramidal shape was more prevalently in the HIFU alone group compared to the combination microbubble and HIFU group (P < 0.05). Following an analysis of the pattern of coagulative necrosis, non-cavitary necrosis was found in ten and cavitary necrosis in six of the samples in the combination microbubble and HIFU group. Conversely, non-cavitary necrosis occurred in all 16 samples in the HIFU alone group (P < 0.05).

Conclusion

HIFU of in vivo rabbit livers with a microbubble contrast agent produced larger zones of ablation and more cavitary tissue necrosis than without the use of a microbubble contrast agent. Microbubble contrast agents may be useful in tissue ablation by enhancing the treatment effect of HIFU.     

联合应用经导管碘油化疗栓塞与高强度聚焦超声治疗原发性肝癌对灭活肿瘤血供作用的影像学研究

目的：从影像学角度观察经导管碘油化疗栓塞(TOCE)联合高强度聚焦超声(HIFU)治疗肝细胞癌是否对肿瘤血供灭活有协同作用。方法：比较40例接受TOCE联合HIFU治疗的病例与同期40例接受单纯TOCE治疗的患者治疗前后数字减影血管造影表现，以及治疗当时与下次复查前采集的腹部平片结果。结果：联舍治疗组肿瘤血管消失及减少比率高于单纯化疗栓塞组。而病灶内碘油清除程度低于单纯化疗栓塞组。结论：TOCE联合HIFU治疗肝细胞癌对肿瘤血供灭活有协同作用，是可以提高肿瘤坏死效果的有效的非手术治疗手段组合。     

Magnetic resonance imaging-guided focused ultrasound thermal therapy in experimental animal models: correlation of ablation volumes with pathology in rabbit muscle and VX2 tumors

PURPOSE: To further investigate the use of magnetic resonance-guided focused ultrasound therapy (MRgFUS) as a noninvasive alternative to surgery in the local control of soft-tissue tumors by ablating prescribed volumes of VX2 rabbit tumors and comparing with ablation of normal tissue volumes. MATERIALS and METHODS: Small, ellipsoidal ablations at shallow depth were created using 5- to 15-second sonication pulses at radio frequency (RF) powers of 50-125 W using a spherical, air-backed transducer operating at 1.463 MHz under MR guidance in a 1.5-T clinical scanner. RESULTS: Excellent correlation was observed between prescribed treatment volumes, MR thermal dosimetry, post-treatment verification MRI, and histopathology. Multifocal ablations of VX2 tumors in rabbits at depths of up to 2.5 cm resulted in complete ablation of the prescribed treatment volume. CONCLUSION: MRgFUS is an effective technique for treating tumors in vivo. Techniques developed for treatments in homogeneous tissue volumes are applicable in the more complicated tumor environment if MR temperature feedback is available to modify treatment delivery parameters.